Aged Care & Rehabilitation Clinical Services Plan 2007 Ã¢Â€Â“ 2012

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Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012respectively for the year, calculated at 85% occupancy. The high average length of stay (ALOS) atCamden is likely to reflect the transfer of long stay patients from Campbelltown Hospital.Liverpool Hospital has a 20 bed acute geriatric ward. In 2004/05, 33 beds at 85% occupancy wereutilised by these patients. At any stage, between 15 and 30 patients have active rehabilitationissues. A number of these patients would benefit from being colocated, with an emphasis on arehabilitation milieu, whilst at the same time having their acute medical needs met at LiverpoolHospital.Bankstown-Lidcombe Hospital does not have a general medicine unit, with geriatricians providingthe general medicine service. This shared service, along with shared aged care/aged carepsychiatry wards, make analysis of activity data for geriatric medicine difficult. The data indicates alarge number of outliers are being treated by geriatricians, with 27 beds outside of the agedcare/aged care psychiatry wards utilised. Bankstown-Lidcombe Hospital also runs a 40 bedrehabilitation unit (including 8 designated stroke beds). Activity in 2004/05 utilised 55 beds.RPAH operated a maximum of 28 acute aged care beds in 2004/05, including winter beds. In2004/05, 34 beds were occupied by acute geriatric and general medicine patients. It is not possibleto disaggregate general medicine from acute geriatric patients in this total bed analysis.Balmain Hospital operates as a stand alone 78 bed geriatric and rehabilitation facility. Patients aretransferred from RPAH to Balmain, predominantly for sub-acute and rehabilitative care. Activity atBalmain Hospital in 2004/05 indicates that 70 beds were required. However, with the changes toacute beds at RPAH, these additional beds are likely to be fully utilised in 2005/06.The CRGH service has a complex service role, incorporating acute and sub-acute aged care, andrehabilitation. The geriatricians also provide general medicine. Until 2005/06 there were nodesignated rehabilitation beds and as such rehabilitation activity is fairly low. In 2004/05, there were88 aged care and general medicine beds at CRGH, however activity suggested the need for 96beds, plus another 5 beds for rehabilitation (totally 101 beds). The development of the 15 bedrehabilitation unit in 2005/06, meets the additional bed requirements at present.Canterbury Hospital operates a general medicine service and an acute and sub-acute aged careservice. Beds are located in shared wards. Current activity in geriatrics suggests that 28 beds, oressentially a designated ward, were required in 2004/05.Average length of stay (ALOS) for patients varies across the hospitals, and is difficult to break downdue to the combination of patients within the data presented. However, it is evident thatrehabilitation patients generally stay for between 20 and 30 days, and aged care patients staybetween 8 and 16 days, depending on their level of acuity. Whilst changes to models of care andother improvements may enable a less variable length of stay to be achieved, clinicians indicate thatlength of stay is unlikely to be greatly reduced, given the ageing population and increasing frailty ofmost patients.Current and Emerging Issues• Population ageing – the increasing number of older people will result in increasing demand forAC&RS beds;• Prevalence of dementia – people with dementia are known to have a four times longer lengthof stay in hospital than older people without dementia. A high proportion of aged care inpatientsalso experience delirium. Improvements to ward environments and staffing may assist inreducing this length of stay;• Younger people with a disability – AC&RS inpatients include younger people with a disability.Some will have ongoing guardianship issues, delaying appropriate discharge;• Emerging models of care – the delivery of community based services for the treatment ofchronic illness, and alternative settings for the delivery of therapy services, may reduce inpatientdemand;• People with complex discharge needs – many AC&RS patients require the coordination of anarray of community services before they can go home, including home modifications and supportservices;• Patients requiring residential aged care placement – a number of patients in each facility willbe awaiting placement in a residential care facility, but for various reasons have not yet beendischarged;Page 52
Aged Care & Rehabilitation Clinical Service Plan 2007 - 2012• Patients with severe aggression – a number of patients in hospital display severe behaviouraldisturbance and aggression. They require specialised care and support, to improve safety forthe patient themselves, other patients and staff. This group of patients are at significant risk ofcreating adverse events and are resource intensive with a high rate of one to one nursing; and• Data and performance management – Data on inpatient activity is variable, due to a range offactors including the inability to sort patients by particular AN-DRGs, the presence of sharedwards and shared specialties, and current data collection issues.Projected Future ActivityProjected future activity and need for additional inpatient beds calculated is based on estimatedactivity in 2004/05 and a clinically validated benchmark of likely future activity. This benchmarksuggests that in the future 0.05% of people aged over 65 years will require an acute aged care bedand have a 12 day ALOS, and 0.03% of people aged over 65 years will require a sub-acute agedcare or rehabilitation bed, with a 20 day ALOS. This includes consideration of increased beddaysassociated with falls and the projected number of patients with dementia/delirium (refer Sections4.1.1, 4.1.2 and 4.1.3).Table 6.12 following indicates that by 2016 there will be over 16,000 separations annually, utilisingalmost 250,000 beddays. If there are no changes to the models of care for AC&RS clients by 2016,over 300 additional beds would be required.Table 6.12 Projected Acute & Sub-Acute Aged Care & Rehabilitation ActivitySouth West2006 2011 (estimated) 2016 (estimated)Services Pop Beds Pop Seps Beddays Pop Seps BeddaysAged Care* 5,099 61,188 6,190 74,274Rehabilitation 87,790 204 101,980 3,393 67,863 123,790 4,119 82,376Total AC&RS8,492 129,05110,308 156,6502006 2011 (estimated) 2016 (estimated)Eastern Services Pop Beds Pop Seps Beddays Pop Seps BeddaysAcute AC 3,283 39,402 3,679 44,149Sub Acute 1,494 29,888 1,674 33,48961,295 230 65,19673,051Rehabilitation 613 12,253 686 13,729Total AC&RS5,391 81,5436,040 91,368Source: Cerner 2004/05 and DIPNR Population Projections 2004Assumptions and Notes:1. The EZ runs a specific sub-acute geriatric service. Equivalent patients in the WZ are treated in rehabilitation beds.2. Where general medicine is provided by geriatricians, it has not been possible to separate the activity. Adjustments of projectedbed numbers downwards are required to reflect this activity (captured in planning for EZ through the RTP, and WZ through theMedicine and Ambulatory Care Plan). General Medicine activity has not been projected for any hospital with a unique generalmedicine service.3. Aged Care activity in the WZ includes aged care psychiatry beds which are planned for in the Mental Health Clinical ServicesPlan. Projected bed numbers will need to be adjusted downwards to reflect this activity.4. Rehabilitation in the WZ includes the stroke unit at Bankstown - also addressed in medicine plan under neurology and thereforeprojected bed numbers may need to be adjusted downwards to reflect this activity.5. Not all rehabilitation clients are aged 65+, though the focus of the service is on older people.It is recognized that it will not be possible to provide the infrastructure required, based on theprojections referred to in Table 6.12, although some beds may be provided through a reconfiguredbed base. However, it is evident that a significant increase in inpatient beds will be required to meetadditional demand over the next 10 years. To counter this demand for AC&RS inpatient beds, arange of supplementary support services, and improved management of all older people within thehospital environment, must be provided. These were discussed throughout Sections 6.1 and 8.Through planning for the Liverpool Hospital Stage 2 redevelopment, it has been agreed to developan additional AC&RS capacity of 30 beds (taking the total bed numbers to 50, in two 25 bed units).Eight of these beds have been dedicated to rehabilitation. The AC&RS units will be complementedby an additional 20 bed aged care psychiatry unit within the proposed AC&RS precinct. It isenvisaged at this stage that these beds will be operational by 2016.Page 53
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Aged Care & Rehabilitation Clinical Services Plan 2007 Ã¢Â€Â“ 2012

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